喉罩复合无肌松麻醉对脑动脉瘤栓塞术应激的影响

谢海玉+李晓玲+蔡婷婷

[摘要] 目的 探讨喉罩复合无肌松麻醉对脑动脉瘤栓塞术应激的影响。 方法 选择实施脑动脉瘤栓塞术的患者80例，将其随机分为观察组和对照组各40例，观察组应用喉罩复合无肌松麻醉，对照组应用气管插管联合肌松药麻醉，比较诱导前（T0）、诱导后插管或喉罩前（T1）、插管或喉罩时（T2）、置入插管或喉罩1 min时（T3）两组患者的心率、平均动脉压及其血糖和皮质醇的变化情况。 结果 观察组麻醉诱导期间心率和平均动脉压及血糖和皮质醇变化差异无统计学意义（P>0.05），对照组T1、T2、T3时间点的心率显著快于T0时间点（P<0.05），平均动脉压显著高于T0时间点（P<0.05），血糖和皮质醇水平均显著高于T0时间点（P<0.05）。 结论 喉罩通气复合无肌松平衡麻醉应用于脑动脉瘤栓塞术，能显著降低患者应激反应，维持循环功能稳定。

[关键词] 喉罩；肌松药；脑动脉瘤栓塞；应激

[中图分类号] R614 [文献标识码] A [文章编号] 1674-4721（2014）09（a）-0123-03

Effect of laryngeal mask without muscle relaxant on stress caused by cerebral aneurysm embolization

XIE Hai-yu LI Xiao-ling CAI Ting-ting

Department of Anesthesiology，the First Affiliated Hospital of Gannan Medical University，Ganzhou 341000，China

[Abstract] Objective To explore the effect of laryngeal mask without muscle relaxant on stress caused by cerebral aneurysm embolization. Methods 80 patients who would received cerebral aneurysm embolization were selected and randomly divided into observation group and control group，with 40 cases in each group.Laryngeal mask without muscle relaxant was given to the observation group，and tracheal intubation combined with muscle relaxant was given to the control group.Changes of heart rate，average arterial pressure，blood sugar and cortisol at the time of before induction （T0），before intubation or laryngeal mask after induction （T1），intubation or laryngeal mask （T2），placed intubation or laryngeal mask 1 min （T3） of the two groups were compared. Results Differences of the changes of heart rate，average arterial pressure，blood sugar and cortisol during anesthesia induction in the observation group were not significant （P>0.05）.The heart rate at T1，T2 and T3 in the control group was faster than that at T0 （P<0.05），and average arterial pressure was higher than that at T0 （P<0.05）.Levels of blood sugar and cortisol at T1，T2 and T3 in the control group were higher than those at T0 （P<0.05）. Conclusion Laryngeal mask without muscle relaxant applied in cerebral aneurysm embolization can significantly decrease the patients′ stress and maintain stable circulatory functions.

[Key words] Laryngeal mask；Muscle relaxant；Cerebral aneurysm embolism；Stress

颅内动脉瘤栓塞术属于微创手术，疼痛感小，对操作要求较高，需要相对稳定的循环环境，应注意预防缺氧和脑血管痉挛的出现。电解可脱卸弹簧圈栓塞术是近些年主要治疗脑动脉瘤的方法，其具有疼痛感低、预后迅速等特点[1]。危险性最高的栓塞术是动脉瘤破裂出血，预防动脉瘤破裂主要应有效控制血压。血压的急性升高是动脉瘤破裂的主要危险因素之一[2]。气管内插管会导致严重的应激反应，引发神经内分泌发生众多变化，从而提高血压。喉罩是一种方便置于咽喉腔的气囊，可将食管和咽喉腔封闭，同时又能通过咽喉通气的人工气道，保留患者的自主呼吸[3]。其不会产生对气管及喉头的机械性刺激，不会造成血液动力学的剧烈变化。本研究主要探讨喉罩通气复合无肌松平衡麻醉对脑动脉瘤栓塞术应激反应的影响。en……